[1]潘同亮,张宪亮,王亚超,等.磁共振弥散张量成像评定四通道功能性电刺激治疗缺血性脑卒中后遗症的可行性[J].中国医学物理学杂志,2024,41(8):982-986.[doi:DOI:10.3969/j.issn.1005-202X.2024.08.009]
　PAN Tongliang,ZHANG Xianliang,WANG Yachao,et al.Evaluation of the feasibility of 4-channel functional electrical stimulation for treating sequelae of cerebral ischemic stroke using magnetic resonance diffusion tensor imaging[J].Chinese Journal of Medical Physics,2024,41(8):982-986.[doi:DOI:10.3969/j.issn.1005-202X.2024.08.009]
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磁共振弥散张量成像评定四通道功能性电刺激治疗缺血性脑卒中后遗症的可行性()
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《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
41卷
期数:
2024年第8期
页码:
982-986
栏目:
医学影像物理
出版日期:
2024-08-31

文章信息/Info

Title:
Evaluation of the feasibility of 4-channel functional electrical stimulation for treating sequelae of cerebral ischemic stroke using magnetic resonance diffusion tensor imaging
文章编号:
1005-202X（2024）08-0982-05
作者:
潘同亮; 张宪亮; 王亚超; 胡川; 王欣
山东省立第三医院， 山东 济南 250000
Author(s):
PAN Tongliang;  ZHANG Xianliang;  WANG Yachao;  HU Chuan;  WANG Xin
Shandong Provincial Third Hospital, Jinan 250000, China
关键词:
磁共振; 弥散张量成像; 四通道功能性电刺激; 缺血性脑卒中; 后遗症; 疗效评价
Keywords:
Keywords: magnetic resonance diffusion tensor imaging 4-channel functional electrical stimulation cerebral ischemic stroke sequelae efficacy evaluation
分类号:
R49；R816.1
DOI:
DOI:10.3969/j.issn.1005-202X.2024.08.009
文献标志码:
A
摘要:
目的：探讨3.0T磁共振成像（MRI）弥散张量成像（DTI）评定四通道功能性电刺激（FES）治疗缺血性脑卒中后遗症患者的可行性。方法：收集2020年2月至2022年11月于山东省立第三医院收治的缺血性脑卒中后遗症患者（n=100），通过Excel产生的随机数字将其以1：1比例分为两组，均接受常规康复训练，观察组在此基础上给予四通道FES模仿正常人行走时肌肉收缩的时序刺激患侧下肢的股四头肌、胫骨前肌、腓肠肌及腘绳肌治疗，对照组在此基础上使用双通道FES治疗仪，将电极置于患肢胫前肌、腓骨长短肌两组肌群的肌肉点上进行刺激。两组患者于治疗前、后均接受脑部3.0T MRI检查，记录并对比两组患者经DTI检查的相关参数，同时使用Berg平衡量表（BBS）及Fugl-Meyer下肢功能评定量表（FMA-LE）评定两组缺血性脑卒中后遗症患者治疗后的临床效果。最后探讨观察组患者BBS、FMA-LE评分与DTI各参数的相关性。结果：对照组与观察组治疗后的FMA-LE、BBS评分均呈现上升趋势，且观察组升高显著（P<0.05）；治疗2周后，观察组的FMA-LE、BBS评分高于对照组（P<0.05）。治疗2周后，观察组的各向异性指数（FA）、平均弥散系数（DCavg）、容积比（VRA）显著高于对照组，衰减指数（Exat）显著低于对照组（P<0.05）。经分析，观察组患者的FMA-LE评分与FA、DCavg、VRA呈正相关，与Exat呈负相关。观察组的BBS评分与FA、VRA呈正相关，与Exat呈负相关，与DCavg无明显相关性。结论：通过DTI可以对四通道FES治疗缺血性脑卒中后遗症患者的疗效进行评价，其各项参数与BBS、FMA-LE评分呈现明显相关性，提示可通过MRI协助医生认识神经功能缺损与神经病理学改变之间的相关性，为准确评估预后及制定个体化康复方法提供参考。
Abstract:
Abstract: Objective To evaluate the feasibility of 4-channel functional electrical stimulation (FES) in the treatment of cerebral ischemic stroke sequelae using 3.0T magnetic resonance diffusion tensor imaging (DTI). Methods Patients with the sequelae of cerebral ischemic stroke who were admitted to Shandong Provincial Third Hospital from February 2020 to November 2022 (n=100) were enrolled and divided into two groups at a ratio of 1:1 according to random numbers generated by Excel. Besides routine rehabilitation training, observation group was given 4-channel FES to stimulate the quadriceps muscle, tibialis anterior muscle, gastrocnemius muscle and hamstring muscle of the affected lower extremity by simulating the time series of muscle contraction of normal subjects when walking while control group was treated with dual-channel FES, with electrodes placed on the muscle points of the tibialis anterior muscle and peroneus longus and brevis muscles of the affected lower extremity for stimulation. All patients received 3.0T MRI before and after treatment, and the relevant DTI parameters were recorded and compared. Meanwhile, Berg balance scale (BBS) and Fugl-Meyer assessment scale for lower extremity (FMA-LE) were used to evaluate the therapeutic efficacies in two groups of patients with the sequelae of cerebral ischemic stroke. The correlation of BBS/FMA-LE score with DTI parameters in observation group was also discussed. Results After treatment, both FMA-LE and BBS scores of control group and observation group showed increasing trends, and the increases in observation group were more obvious (P<0.05). After 2 weeks of treatment, compared with control group, observation group had higher FMA-LE score, BBS score, fractional anisotropy (FA), average diffusion coefficient (DCavg) and volume ratio anisotropy (VRA), but lower exponential attenuation (Exat) (all P<0.05). In observation group, FMA-LE score was positively correlated with FA, DCavg and VRA, but negatively correlated with Exat while BBS score was positively correlated with FA and VRA, but negatively correlated with Exat, and had no significant correlation with DCavg. Conclusion DTI can be used to evaluate the therapeutic efficacy of 4-channel FES on the sequelae of cerebral ischemic stroke, and its parameters are significantly correlated with BBS score and FMA-LE score, suggesting that MRI can assist doctors in understanding the correlation between neurological impairments and neuropathological changes, and provide reference for accurate assessment of prognosis and formulation of individualized rehabilitation program.

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备注/Memo

备注/Memo:
【收稿日期】2023-12-05 【基金项目】教育部人文社会科学基金（19YICZH255）；山东省中医药科技发展计划（2017-283）；山东省中医药科技项目（2020M047）；山东省医药卫生科技项目（202316010540） 【作者简介】潘同亮，主治医师，研究方向：脑卒中相关疾病，E-mail: P79713666@163.com 【通信作者】王欣，硕士，主任医师，研究方向：神经系统疾病，E-mail: 18530915@qq.com
更新日期/Last Update: 2024-08-31